Friday, August 28, 2009

Saving Money: B.Y.O.P.

* bleeeeep bleeeeep bleeeeep *

It was 11:57PM on the alarm clock last night. I peeled my head from the pillow and felt my heart racing from the adrenaline surge that usurped by Stage IV REM sleep. I fumbled for the pacer and pressed the button. Glorious silence ensued as I caught my breath. Reading the pager, I noticed it was the nurse caring for my patient calling. I dialed the phone.

Some cheesy commercial played in the background with some canned music that I had heard a thousand times before. 'Damn, why don't they just play some soft classical music?' I thought to myself. Just then, a voice answered.

"This is Sally..."

"Sally, Dr. Fisher, returning your call..."

"Yes, Mr. Faachamatacheesedip is having trouble sleeping. Can he have a sleeping pill?"

My heart raced again, but I kept my composure and acquiesced. Sure." Then I prescribed a sleeping pill as requested and the nice nurse thanked me and I was back to lying an bed, staring at the ceiling, thinking about ways to cut health care costs. I do that sometimes. Especially when I've been awakened for a sleeping pill.

Every day, countless times across the country, thousands of doctors prescribe tylenol and sleeping pills and countless other "preventative" medications just so they don't get these calls at night. I wondered how many millions of dollars could be saved, but realized with the savings comes a price: the need to make another call to the doctor. Would this really save money? Hard to tell. Would doctors sleep worse? Probably.

Better still, what if we allowed patients to take their own chronic medications that they have been using for years when they have already paid for when they come in the hospital for routine procedures? These medications could be registered on the patient's electronic medical record and designated as "self-adminstered" to assure that the nurses and doctors caring for the patient knew which medications they were actively taking during their medication reconcilation process performed when they enter the hospital.

9 comments:

Debra
said...

Pts can bring their own at my hospital with MD order, but here's the catch, the pharmacy must inspect and verify(and of course charge for these services). No narc or sleeping pills etc allowed due to federal regulations regarding storage or so we have been told.

We're in the process of opening an observation unit and trying to make things as simple as possible. THe first idea we had was to allow patients to do just that, BYOP, especially as Medicare does not pay for medications in true observation patients. Then the idea went to pharmacy. Shot down like a sweaty guy in a bar. First, we would have to submit all of the patients meds to pharmacy so they could verify that they are what the patient says they are. Then we would have to design a secure area to hold said medications in as the docs and pharmacy didn't really want the patients to have access at any time to their own meds, most notably the narcs. What seemed like a simple and easy idea spiraled into a convoluted mess and ended up being dropped as an idea.

As for sleepers and Tylenol, we added meds like that into the pre-printed orders so that the docs could order them on admit, instead of being wakened at 1am for a patient who can't sleep. We'll see if that works...

my last hospital stay ..they would not allow me to bring in my own medicines. Insurance wouldn't pay for meds in pill form (because they'd already paid for that days supply and they're not going to pay for the same med twice is the supposed reasoning) So I wound up with a bill of $2400 for medications that I already had in my possession.

(yes, I'm on some pricey meds) however ..there were 3 meds I take routinely that they did not have in stock ..and there was no substitute ... so they let me take my own. Go figure.

Hey Wes: Great post. More common sense. On the subject of common sense and saving money on meds, I put together a website for my patients (www.MyDrugRebate.com) that gives people access to manufacturer rebates on branded drugs. The drug reps think it is our job to tell people about these deals but the truth is that we don't have the time to hand out discount cards. Some of these rebates are huge, $600! in a couple of cases. Only catch is can't use them with Medicare or Medicaid.

If I was ever admitted to a hospital observation status, I would refuse all my home pills the hospital was trying to give me and take my own. Or have my family member bring them in.

My last in-patient stay, my room nurse told my wife to remove all home meds from the room or she would notify my hospitalist that I was "non-compliant" and would have security escort my wife from the hospital.

I had been admitted to a floor from the ER, had brought my meds along for med history, my wife took control of the meds for when she went home that P.M. and I never said/did anything to lead them to believe that I would use my own meds instead of hospital pharmacy meds. Just the fact that she had them along while they were settling me in my room was enough to almost get her ejected and me a black mark on my med record.

As a registered nurse, home meds are a nightmare because they can be expired, discontinued, or cross-react with new meds; And how do we document them, as we have no orders, and we are not allowed to work without orders. As a mother, family caregiver, and patient I have used my own and given home meds to family while in the hospital. There is no common sense involved, it all goes back to liability and lawyers........

The frustrating thing to me is that when I'm home, I take my medications at 7 am and 7 pm. It's down to a habit now and I don't miss medications. I'm on the lowest dose of most of my medications because they are taken like they are supposed to be. When I go into the hospital, usually I have to remind the (way too busy) nurses that I need to take medications and half the time the admitting doctors have failed to write orders for them (or so I'm told.) It becomes insulting to me to be treated like an imbecile who can't properly manage taking pills that I manage better than they do.

In my hospital, patients can bring in and take their home medications with MD approval. The meds are sent for verification to the pharmacy, where the patient's container is labeled with a barcode compatible with our computer med administration checking. Then they are kept in the patient's drawer in the unit's med room and dispensed by the nurse until the patient goes home. From my perspective as a nurse, this system works very well with very little hastle.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.